Dr. Margaret Greenwood – An Interview With An OB/GYN Visiting From The US.
Posted on 14. Jul, 2010 by afyakenya in Blog
Often times we don’t get as much time to speak with our doctor during a visit as we might like. We might not get the chance or forget to ask general questions. Our interview with Dr. Polaneczky might help answer some of those questions you have been meaning to raise. She sheds light on the HPV vaccine and abnormal Pap tests, and she offers some general tips on healthy living.
What led you to decide on OB/GYN as a specialty
My decision to enter the field came from a desire to give women a voice in our reproductive health, a voice that, at the time, I wasn’t sure the men who dominated the field were hearing. Now, over 20 years later, I’ve realized that we women gynecologists have probably not changed things as much as I had hoped — we’re just too busy getting the work done. Still, I couldn’t imagine myself doing anything else!
Do you see many women with abnormal Pap tests? How do you counsel them?
I am privileged to work at Cornell Medical College, where George Papanicolou invented the Pap test (smear) in 1942. We have a bust of him in our lobby that I pass every day when I come to work, reminding me how the work of just one individual can change the lives of millions.
And yes, I treat women with abnormal Pap tests. Fortunately, for the overwhelming majority of these women, the abnormal Pap will ultimately prove to be nothing more than a short-lived infection with HPV — human papillomavirus — that will resolve within 1 to 2 years. For these women, I counsel them to avoid cigarette smoking, use condoms, and eat four to six servings of fruits and vegetables daily. These are all strategies shown to shorten the duration of HPV infection. For the small percentage of women whose abnormal Pap indicates precancerous cell changes, we can easily and effectively treat them so that they never develop cervical cancer. This is similar to removing a precancerous skin mole to prevent skin cancer.
What do women need to know about the HPV vaccine?
The HPV vaccine immunizes against HPV16 and 18, the two strains of HPV that cause about 70 percent of cervical cancers in the United States. The vaccine is safe, and at least for as long as it has been studied, effective against infection with these two strains of HPV. Whether it will ultimately protect against cancer remains to be seen. In this regard, it is important to understand what the HPV vaccine does not do. It does not protect against all strains of HPV (and there are over 20 of them!). So, we don’t know, for instance, if over time, we will begin to see cervical cancer rates decreasing as the vaccine becomes widely used, or if other strains of HPV will step in to fill the void. If you are already infected with HPV strains 16 or 18, the vaccine will not make them go away more quickly. While there may be some crossover protection against other strains, we do not know if the vaccine will ultimately prevent infections or cervical cancer from these strains. Finally, we do not yet know how long the vaccine remains effective — will we need to give boosters at 10 or 20 years later? Given the duration of sexual activity in women’s lives, as well as the trend towards multiple sexual partners at all ages, this is a very important question. Today, most of us are infected in our younger years with HPV and develop natural immunity that protects us in later years. Will the immunity from the HPV vaccine protect us as well? Only time will tell.
All of that said, I have no concerns about the safety of the vaccine, and I do offer it to my patients — as long as they understand its limitations. Ultimately, I wait for the day that we have a vaccine that covers all the known HPV strains, is cost effective, and is widely available to those who need it most — namely women in the developing world without access to regular Pap tests.
If women are too old to get the vaccine, how can they protect themselves from HPV?
Many of these women are already protected from HPV due to natural immunity from prior infections that have gone away.
The most important thing to do to protect against HPV is to limit your number of sexual partners. It’s become almost my mantra — limit sexual activity to those you really care about (dare I use the word “love”?) and you’ll be ahead of the rest of your peers in preventing cervical cancer. And of course, use condoms with new partners, though these are not 100 percent effective against the HPV virus.
But you know what? Even if you do all those things, you may still get HPV. A recent study found that in 50 percent of newly formed young couples, one or both partners had HPV.
At some point, if you really care about someone, you need to just be with them and let the fear go. Get the vaccine if you are of age, but know it is not 100 percent protective and not a blessing to sleep around. And most importantly, get your Pap test — odds are we’ll pick up any problem long before it’s going to put you at significant risk. The Pap test has served us extremely well for over half a century, most of which time we had no idea HPV even existed.
What are the most important things that women can do to protect their reproductive health?
Limit your number of sexual partners, use condoms with new partners and always use effective contraception unless you are planning a pregnancy. Have regular Pap tests and know your family health history so you and your doctor can plan for targeted screening or prevention when it’s appropriate and available. Eat a healthy balanced diet, maintain a normal weight, and exercise regularly. And, oh yeah — don’t smoke.
You love cooking. How can women balance eating great food and staying physically fit?
If you remember that all food has calories and know how many calories you need on a daily basis to support your energy expenditure, then it’s a matter of simple mathematics to figure out how much wonderful food you can eat and still maintain a healthy weight (or in my case, lose the excess weight). Add in exercise and you can eat (or lose) more, and have the added benefit of feeling and looking better, not to mention helping keep your blood pressure and cholesterol in a healthy range.
Regards,
Oduwo Noah Akala
Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org
Recent Comments